Theory vs. Practice: Long-Acting Stimulants in the Real World

A small study sheds light on how ADHD medications perform for adolescent patients in a school setting.

Most children diagnosed with ADHD will have symptoms that persist into adolescence. Stimulant medication is often prescribed to patients at diagnosis and into the adolescent years, helping around 80% of ADHD patients find symptom relief. Many studies have examined stimulant use in children, but comparatively few are conducted in adolescent populations, and to date, none have looked at naturalistic (real-world) measures.

Now, researchers at Florida International University’s Center for Children and Families have conducted a small study examining stimulant medication effectiveness and adherence in adolescents with ADHD in their natural secondary school environment. Their study was published online on March 4, 2013, in the Journal of Attention Disorders.

During 12-week grading periods, the researchers randomly assigned participants to take short-acting methylphenidate 3 times daily, short-acting pemoline once daily in the morning, or placebo once daily in the morning. (For each new grading period, participants were switched to a new medication regimen.) The participants and their parents, teachers, and school administrators all watched for abrupt performance changes. If a given medication regimen caused such deterioration, the researchers discontinued the dose and the adolescent began the next randomized regimen. The researchers measured grades, ADHD symptoms, academic performance, medication adherence, and patient satisfaction with each drug.

The researchers reported 4 primary findings:

• Short-acting methylphenidate was associated with statistically significant improvements in ADHD symptoms and note-taking habits compared with placebo. Long-acting pemoline was not.
• Both active drugs were associated with better grades, fewer oppositional/defiant symptoms, and improved academic habits.
• Adherence was better with long-acting pemoline and morning doses of methylphenidate than with noon and afternoon methylphenidate doses.
• Adolescents were more satisfied with short-acting methylphenidate than with long-acting pemoline or placebo.

The researchers note that stimulant medication did produce some gains for adolescent patients, but none of the gains were of the magnitude reported in analogue settings.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.